Estimated pulmonary capillary wedge pressure assessed by speckle tracking echocardiography predicts successful ablation in paroxysmal atrial fibrillation

Cardiovascular Ultrasound

Research

Shinji Tomita¹  Kunihiko Tsuchiya¹  Yoshiaki Kawase¹  Taiji Miyake¹  Hitoshi Matsuo¹  Mayumi Kaneda²  Ryuhei Tanaka²  Takeshi Hirose²  Maki Nagaya²  Toshiyuki Noda²  Reiko Matsuoka²  Koji Ono²  Masanori Kawasaki³  Shingo Minatoguchi³  Shinya Minatoguchi³  Hidemaro Sato⁴ 

[1] Department of Cardiology, Gifu Heart Center, Gifu, Japan;Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan;Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, 501-1194, Gifu, Japan;Department of Internal Medicine, Sawada Hospital, Gifu, Japan;

关键词: Atrial fibrillation ablation;    Recurrence;    Pulmonary capillary wedge pressure;    Speckle tracking echocardiography;   

DOI  :  10.1186/s12947-016-0049-4

 received in 2015-12-12, accepted in 2016-01-19,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundAtrial fibrillation (AF) is associated with left atrial (LA) remodeling caused by pressure and/or volume (LAV) overload. Increased pulmonary capillary wedge pressure (PCWP) represents LA pressure overload. We recently reported that pulmonary capillary wedge pressure (ePCWP) can be estimated by the kinetics-tracking (KT) index that combines LA function and volume using speckle tracking echocardiography (STE), and has a strong correlation with PCWP measured by right heart catheterization (r = 0.92). Therefore, we hypothesized that ePCWP is the best echocardiographic predictor of successful AF ablation.MethodsWe enrolled 137 patients with paroxysmal AF (age: 61 ± 10 years) who underwent pulmonary vein isolation. We measured LAV index, LA emptying function (EF) and LA stiffness during sinus rhythm before ablation using STE. PCWP was noninvasively estimated by STE as we previously reported. Parameters were compared between a group with AF recurrence (n = 30, age: 59 ± 11 years) and a group with successful ablation (sinus rhythm maintained for >1 year) (n = 107, age 61 ± 11 years).ResultsThe ePCWP was correlated with PCWP measured by right heart catheterization (r = 0.76, p < 0.01). Compared with the non-recurrence group (n = 107, age: 61 ± 11), the AF recurrence group had significantly increased ePCWP (10.6 ± 3.5 vs 14.6 ± 2.9 mmHg, p < 0.01), minimum LAV index (29 ± 12 ml/m2 vs 37 ± 14 ml/m2, p < 0.01) and LA stiffness (0.47 ± 0.33 vs 0.83 ± 0.59, p < 0.01), but lower total LA EF (44 ± 11 % vs 39 ± 13 %, p < 0.01) before ablation. In multivariate logistic regression analysis, ePCWP was the most significant independent predictor of successful ablation. Using 13 mmHg of PCWP as the optimal cutoff value, the sensitivity and specificity for successful ablation were 73 and 77 % (area under the curve = 0.81), respectively.ConclusionThe ePCWP that is measured by the combination of LA function and volume before ablation was a better predictor of the successful ablation compared with LA function and volume separately. The ePCWP estimated by STE is useful to predict the successful ablation in paroxysmal AF, and could be useful to improve candidate selection for AF ablation.

【 授权许可】

CC BY   
© Kawasaki et al. 2016